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Expensive sham medication causes stronger side effects than cheap ones
If patients know that medication can have side effects when taking a medication, the complaints often set in. As German researchers now report, this so-called nocebo effect is further enhanced if the dummy drug is an expensive preparation.
Placebos work for various ailments
It has long been known that mock medicines, so-called placebos, can help with various complaints, such as against chronic back pain. In addition to the "placebo effect", which is known to most people, there is also the little-known "evil twin of placebo", the so-called "nocebo effect". In this case, dummy medication can also have adverse effects. According to a new study, this effect is exacerbated if the supposed drug is an expensive preparation.
Expensive dummy medication causes more severe side effects than a cheap one
When people are told that a certain medication can cause side effects, they often set in - even if it is an active substance-free sham drug.
This so-called nocebo effect is exacerbated when the patients receive value information about the supposed medication. An expensive sham drug causes stronger side effects in the test than an inexpensive one.
Scientists from the University Medical Center Hamburg-Eppendorf (UKE) examined these relationships in a study; their results have now been published in the "Science" magazine.
Expectations of the patients
This phenomenon can be traced back to the expectations of the patients, which can even be visualized with imaging methods.
"The modulating pain system is very important when it comes to expected effects," said Alexandra Tinnermann, scientist at the UKE's Institute for Systemic Neurosciences.
“Expectations that arise in the frontal brain can influence the processing of painful stimuli in deeper regions of the nervous system such as the brain stem or spinal cord via the modulating pain system,” explains the expert.
In order to be able to examine the modulating pain system under negative expectations, they used a new method of functional magnetic resonance imaging (fMRI).
"In our investigation, we were able to show that negative expectations have an impact on three important areas of the modulating pain system - on the frontal brain, brain stem and spinal cord."
Placebo and nocebo effect
In clinical trials, patients who are in the placebo group and who have received a drug without an active ingredient frequently report side effects. These often match the possible side effects of the actual medication.
A dummy medication can therefore not only improve the symptoms (placebo effect), but also cause the side effects of the actual medication (nocebo effect).
"In our study, we examined how value information about a drug affects the nocebo effect," says scientist Tinnermann.
For this purpose, the test subjects received a dummy medication without a medicinal agent. In order to arouse a negative expectation, the test subjects were informed that the drug can cause side effects that lead to an increased sensation of pain.
In addition to this negative expectation, half of the subjects were informed that the drug was cheap, the other half that it was expensive.
The group that received the expensive sham drug showed a greater nocebo effect - that is, a higher sensation of pain - than the group that received the cheap drug.
“The results show that the value of a drug, in addition to negative expectations, can affect pain; The processing of pain stimuli in the spinal cord is also affected by these factors, ”says Tinnermann. (ad)